1467230441 NPI number — MARROD HEALTHCARE PROVIDER, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467230441 NPI number — MARROD HEALTHCARE PROVIDER, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARROD HEALTHCARE PROVIDER, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467230441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25914 SUNDROP MEADOWS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-3171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5330 FRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77449-6920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-810-5060
Provider Business Practice Location Address Fax Number:
832-810-5080
Provider Enumeration Date:
09/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ PENTON
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
ENRIQUE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-407-6082

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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